UBRARY
Cornwall County Council
ANNUAL REPORT
OF THE
MEDICAL OFFICER OF HEALTH
FOR THE YEAR 1943.
Oscar Blackford Ltd, Royal Printeries, Truro.
Cornwall County Council
ANNUAL REPORT
OF THE
MEDICAL OFFICER OF HEALTH
FOR THE YEAR 1943.
Oscar Blackford Ltd, Royal Printeries, Truro.
To the Chairman and Members of the Cornwall County Council.
My Lord, Ladies and Gentlemen,
I have tlie honour to present the Annual Report on the Health of the
County of Cornwall during the year 1943.
The health of the County during the year continued to improve in spite
of the stresses and strains of war-time conditions. One of the most sensitive
indicators of the state of the public health is the Infant Mortality rate, and
it will be seen from the body of the Report that this reached a record low
level, far below the corresponding figure for the rest of the country. The
five-year average of the Maternal Mortality rate also fell to a record low
level, and for the first time in the history of the County it is recorded at a
rate of less tlian 3 per thousand births.
•
The Council has continued to deal vigorously with the problem of
providing sufiicient maternity accommodation in the County. During 1943
an Annexe to the County Maternity Ward was opened at Trewirgie Corner
in conjunction with the Camborne-Redruth Miners’ & General Hospital and
provided an additional 15 beds for maternity cases. Later in the same yean
the Bodmin Maternity Home was taken over by the County Council from
the Ministry of Health and added a further 12 beds to the maternity accom-
modation available for Cornish mothers. Even so, the demand for accommo-
dation in the Council's Maternity Institutions continued to rise, and it was
necessary during the year to contemplate the provision of still further
accommodation for maternity cases.
One of the greatest problems which affected all the County Council’s
Medical Institutions was the difficulty of obtaining sufficient nursing and
domestic staff. The adoption of the Rushcliffe Committee’s recommenda-
tions increased the amount of off-duty time for nurses at a time of great
shortage of nursing staff, and made tlie administration of the Hospitals
extremely difficult. Nevertheless, every effort has been made to give the
nurses the off-duty time which they so richly deserve, and it is only fitting
that a tribute should be made to those who willingly sacrificed their off-duty
time in moments of emergency and uncomplainingly worked longer hours in
order to cope with staffing difficulties.
I repeat my acknowledgment of the help and consideration I have
received from the Chairman and members of my Committee, both collectively
and individually, and the loyal assistance I have received from my Staff.
I am.
Your obedient Servant,
R. N. CURNOW,
County Medical Officer.
September 1944.
CONTENTS.
Page
Statistics and Social Conditions
5
Laboratory Facilities
6
Ambulance Facilities
7
Sanitary Circumstances
9
Housing
9
Inspection and Supervision of Food
9
Infectious Diseases
12
County Isolation Hospital
12
Tuberculosis
14
Venereal Diseases
24
Cancer
25
Blind Persons
27
Vaccination
29
Maternity and Child Welfare
29
Report of Supervisor of Midwives
32
Work of the County Nursing Association
36
Infant Welfare Centres
37
Orthopaedic Treatment
'38
Tables and Graphs
... At end
CORNWALL COUNTY COUNCIL
REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE
YEAR 1943.
STATISTICS AND SOCIAL CONDITIONS OF THE AREA.
Area 864,126 acres.
Population, 1943 (excluding Scilly Isles) ... 327, 163 (Registrar General’s
estimate) .
Number of inhabited houses (1931 census) ... 83,544
Rateable Value ;^i,586,348
Sum represented by a penny rate ... ^^6,293
The chief industries according to the 1931 Census were: —
Males.
Females.
Total.
Agricultural
22,588
1,204
23.792
Clay, Sand, Gravel, etc. pits ...
3.883
41
3.924
Tin and Copper Mines
665
12
677
Other Mines
2.556
18
2.574
Stone Quarries, Mines, etc. ...
2,068
14
2,082
Fishing ...
2,488
5
2.493
These figures exclude those persons out of employment on Census Day.
Male.
Female.
Total.
Legitimate
2,378
2,246
4.624
Illegitimate
183
163
346
Total
2,561
2,409
4.970
Birth rate per i
,000 of the population 15.19.
Still Births.
Male.
Female.
Total.
Legitimate
80
75
155
Illegitimate
5
‘ 4
9
Total
85
79
164
Deaths.
Male.
Female.
Total.
2,201
2,388
4.589
Death rate per
1,000 of the population.
14.02.
Deaths from Puerperal causes: —
Puerperal Sepsis ... 7 Rate per 1,000 total (live and still) births 1.36
Other Puerperal causes 6 ,, ,, ,, ,, 1.17
Total ... ... 13 ” " ” ” ^’53
Deatli rate of infants under i year of age: —
All infants per i,ooo live births
Legitimate infants per i,ooo legitimate live births
Illegitimate infants per i,ooo illegitimate live births
Deaths from Cancer (all ages)
,, ,, Measles (all ages) ...
,, ,, Whooping cough (all ages)
,, ,, Diarrhoea (under 2 years of age)
35-8i
35-47
40.46
656
4
4
II
Comparative Rates. Cornwall. England&Walcs.
Live births, rate per 1,000 civilian population ... 15.19 16.5
Stillbirths, rate per 1,000 civilian population ... 0.50 0.51
Total deaths under i year, rate per 1,000 live births 35.81 49.
Diarrhoea, under 2 years, rate per 1,000 live births 2.21 5.3
Deaths from all causes, per 1,000 of the population 14.02 12. i
,, Enteric Fever per 1,000 of the population 0.003 o-oo
, , Measles
# r
it * t
0.012
0.02
,, Scarlet Fever ,,
i i It
0.006
0.00
,, Whooping Cough ,,
It It
0.012
0.03
, , Diphtheria
f f
It II
0.036
0.03
,, Influenza
i t
II It
0.443
0.37
Maternal Mortality
Puerperal sepsis ...
1.36
0.73
rate per 1,000
Other puerperal causes ...
1. 17
1.56
total births.
Total
2.53
2.29
Birth Rate.
The birth rate in Cornwall for 1943 was 15.19 as compared with 14.34
for 1942, and 16.5 for England and Wales.
Infant Mortality.
The infant mortality rate was 35.81 per 1,000 live births as compared
with 49 for England and Wales. Of the 178 infant deaths, 119 were due
to congenital debility, premature birth, malformations, etc.
Death Rate.
The death rate for Cornwall (14.02) is higher than that for England
and Wales (12.1).
Chief causes of death at all ages: —
Diseases of Heart and Blood Vessels ... 1,460
Cancer ... ... ... ... 656
Intracranial Vascular lesions ... ... 472
Respiratory disease ... ... ... 367
Tuberculosis ... ... ... ... 200
Nephritis ... ... ... ... 165
Suicide and deaths from violence ... 15 1
Influenza ... ... ... ... 145
Congenital Debility, premature birth, etc. 119
GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA.
Laboratory Facilities.
The Royal Cornwall Infirmary, Truro, Pathological Department, under
the charge of Dr. F. D. M. Hocking.
7
The Redruth ClinLai Laboratory under the charge of Dr. C. Rivers.
The Laboratory of the Public Analyst (Dr. H. E. Cox), ii, Billiter
Square, London, E.C.3. Specimens of water and food, etc., are sent to this
Laboratory by the County Council.
District Councils make their own arrangements with various Laboratories.
Ambulance Facilities.
Motor ambulances are provided and maintained by voluntary organisa-
tions, and there is a Joint Committee of representative members of the British
Red Cross Society and The Order of St. John, the Cornwall Voluntary Aid
Organisation.
The following are the motor ambulances connected with this organisa-
tion;—
Station.
Garage.
Officer-in-Charge .
St. Austell
South Street.
Commandant S. Rowley,
B.R.C.S..
Varennes, Penwithick Rd.,
Tel. 261.
Bodmin
Ambulance Station.
Tel. 198.
Supt. W. W. Hearn,
St. J.A.B., 14, Clifden Tee.
Tel. 42.
Camborne
College Street.
Supt. J. Jory,
S.J.A.B., 6, Mid Centenary
Row. Tel. 3215.
Camelford
Ambulance Station.
Tel. 53.
Supt. W. R. Treweeks,
S.J.A.B., Simnyside,
Tel. 53.
Carnmenellis
New Road, Stithians.
Supt. S. T. Bowden,
and Stithians
Tel. 25.
St. J.A.B., Velandrucia,
Stithians. Tel. 23.
Falmouth
Ambulance Hall, Quarry
HiU. Tel 83.
Supt. J. Jackman,
S.J.A.B., Hazeldene,
Albany Road. Tel. 583.
Goldsithney
Fore Street, Goldsithney.
Tel. Marazion 162.
Supt. R. C. Edwards,
St. J.A.B., Fore St.,
Tel. 162.
Hayle
Ambulance H.Q. Tel. 3355.
Supt. J. R. Bond,
,S.J.A.B., 15, Copper Tee.,
Helston
Wendron Street. Tel. 58.
Supt. J. B. Gilbert,
S.J.A.B., II, Meneage St.,
Tel. 58.
lUogan
Agar Road, Pool.
Tel. Redruth 417.
Supt. R. J. Richards,
S.J.A.B., 10, Agar Road,
Illogan Highway,
Redruth. Tel. 417.
St. Ives
Dove Street.
Supt. W. H. Care,
S.J.A. Div., Gabriel Street,
Tel, 81.
8
Station
Garage.
Officer-in-Charge.
Launceston
Ambulance Station,
VVestgate Street. Tel. 32.
Supt. W. G. Mooney,
S.J.A.B., St. Mary’s,
Tavistock Road.
Tel. 32 &83.
Liskeard
Ambulance Station, Fair
Park.
Sergt. H. H. Wenmoth,
S.J.A.B. Tel. Day 124,
Night, 278.
Looe
Mill Pool, West Looe.
Supt. A. J. Pengelly,
St. J.A.B., Kilhallon
Cottage, East Looe.
Tel. 92.
Pendeen
Trewellard, Pendeen.
Amb.Off. D. J. Briggs,
S.J.A.B. Tel. St. Just 52.
Penryn
Ambulance Station.
Tel. 2145.
Supt. J. H. Tresidder,
St. J.A.B., II, Western
Place. Tel. 2145.
f’enzance
St. John’s Car Park.
Tel. 287.
Supt. T. C. Cooper,
S.J.A.B., 14, Alverton St.,
Tel. 287.
Redruth
Headquarters, S.J.A. Div.,
Basset Street. Tel. 159.
Supt. C. C. Pellowe,
S.J.A.B., I, Close Hill,
Tel. 159.
Iruro
City Road.
Tel. 2439.
Supt. W. E. Bennellick,
S.J.A.B., 14, St. George’s
Villas. Tel. 2233.
Four new Ambulance Stations were established during the year at
Carnmenellis and Stithians, Goldsithney, Penryn, and Looe.
In addition to the above, there are also ambulances at Bude, Newquay
and Torpoint.
These ambulances are not available for ordinary infectious disease, but
are used in connection with the Council’s Public Health Services. The
County Council make a grant of £io per ambulance to the Cornwall Voluntary
Aid Organisation, to be devoted solely to expenses in connection with road
accidents.
An interesting recent development in the Ambulance Services of the
County is the establishment of a central co-ordinated office for Ambulances
provided by the British Red Cross Society and the Order of St. John.
Tne Ambulances maintained by these Organisations carry out their
normal work in their own districts without reference to the co-ordinating
Centre which is maintained in Truro, but if an Ambulance is required to
move out of its own area, an enquiry is first sent to the co-ordinating Centre to
see whether there is any other case which can usefully be picked up by the
Ambulance on its journey to and from its destination. Hospitals at Plymouth
and in Cornwall telephone this Central Bureau in the morning if they have
any cases requiring transport which would take an Ambulance out of its
ordinary district, and these journeys are arranged by the Central Bureau.
The present purpose of the Bureau is the saving of rubber and petrol used
9
on unnecessary jcinneys, but it seems that this central co-ordination is
serving such a useful purpose that it might well continue into peace-time.
As an example of the amount of work done by this Central Bureau, it was
stated that during two months it arranged transport -for 476 cases.
In addition to these normal Ambulance Services maintained in the
County, there is also an Ambulance maintained in connection with the
County Isolation Hospital, and 64 whole time Civil Defence Ambulances
which are used for various Public Health purposes in addition to their
normal Civil Defence duties.
SANITARY CIRCUMSTANCES OF THE AREA.
County Councils are not Sanitary Authorities for such purposes as water
supply, sewerage, and the arrangements for dealing with infectious disease,
but under the Local Government Act, rgag. County Councils may make
grants to District Councils in aid of schemes for water supply and sewerage.
Grants have been made by the County Council in aid of water supplies for
rural areas.
Rivers and Streams. Action to check pollution of rivers or streams may
be taken by District Councils or by the County Council.
Schools. The sanitary condition and water supply of the Schools is
constantly receiving tlie attention of the Education Committee, and as oppor-
tunity offers Schools are connected with water and drainage schemes.
It is hoped that with the reorganisation of the education arrangements
in Cornwall about to be undertaken under the Education Act, 1944, many
of the primitive sanitary arrangements at our Schools will disappear.
HOUSING.
Housing Act, 1936, and Housing (Financial Provisions) Act, 1938.
Grants of ;^i per house per year for 40 years have been approved in respect
of houses erected for the accommodation of the agricultural population in the
following Districts: —
District
Camelford Rural
Kerrier Rural
Launceston Rural
Liskeard Rural
St. Germans Rural
Stratton Rural
Truro Rural
Wadebridge Rural
West Pen with Rural
No. of houses.
8
56
6
8
9
8
22
26
35
INSPECTION AND SUPERVISION OF FOOD.
Milk (Special Designations) Orders, 1936 and 1938. These Orders pro-
vide that no person may use a " special designation ” for any milk unless
there is in force a milk licence authorising the use of that designation in
connection with that milk, nor may any description be used in regard to the
sale of milk which is calculated falsely to suggest that the cows are free
lO
from tuberculosis or that the milk has been graded or tested by any competent
person.
The County Council is responsible for the granting of licences for the
production of Tuberculin Tested milk and Accredited milk. In granting
these licences the County Council works in close touch with the local Sanitary
Authority, whose officers are invariably consulted before the issuing of any
such licence is recommended.
Tuberculin Tested. Accredited.
No. of licences on 31st December,
1936
36
232
9 f ft ft > *
1937
36
299
tf ft »» »t
1938
60
328
ft ft ff t t
1939
96
400
ft ft f » t •
1940
100
462
ft t f ft ft
1941
104
471
ft m 1 1 ft ft
1942
105
486
ft ft t f t »
1943
125
497
The following number of samples
were taken during the
year, with the
results shown: —
Tuberculin Tested.
Accredited .
No of samples taken
. . .
405
1.599
,, ,, satisfactory
297
1,140
, , , , unsatisfactory
...
108
459
The unsatisfactory samples were made
up as follows: —
Failed Methylene Blue Reductase Test
38
158
Excessive bacillus coli content
. . .
40
205
Failed Methylene Blue Reductase Test
and Excessive B.Coli content
30
96
MILK SUPPLIED TO SCHOOLS.
Returns of the number of children receiving milk in schools at the end
of the year are not available, but early in 1944 the figure was 19,991, substan-
tially that given in my last report. This represents about 68% of the school
population, and is still far below what is desirable. Difficulties in supply
still remain in a few places and 19 departments are as yet without milk.
Every effort is made to maintain a high quality in the milk supplied and
recent additions to the staff of the Chief Dairy Instructress have made it
easier to supervise supplies, particularly of undesignated milk. Wherever
this has to be provided, it is a condition of approval that the milk shall be
boiled. It is very much to be regretted that all school milk cannot be
delivered in one-third pint bottles and drunk through straws. Bulk supplies
are inevitable at the present time, but few rural schools possess the necessary
facilities for dealing with them adequately or for washing cups or mugs in a
satisfactory manner.
II
Adulteration, etc.
Samples taken during the year under the Food and Drugs (Adulteration)
Act, 1938, were as follows: —
Name of Article
Number
of
Samples
taken
Genuine
Adul-
terated
Remarks
Baking Powder
6
4
2
Deficient in Carbon-dioxide
Barfee
1 .
1
—
Barley Sugar Sticks
1
1
■ -
Beef Extract
1
1
■
Beef Suet
1
1
Blackcurrent Cordial
1
1
Butter
14
13
1
Contained excess of water
Cake and Pudding Mixture
20
20
Chocolate Spread
2
2
Citrus Products
4
3
1
Lime Cordial not a Cordial
Cloudy Ammonia
1
1
Cocoa
1
1
Deficient in fat
Coffee and Coffee Powder ...
5
5
Colourless Tincture of Iodine
1
1
Cooking Fat
1
1
Curry
2
2
Dried Egg Mixture
2
2
Drisauce
1
1
Drugs
8
8
.
Forcemeat
1
1
Fruit Jubee
1
1
Gelatine
5
4
1
Large excess of zinc and
copper
Gravy Powder
2
2
.
Lard
9
9
Lemon Barley Crystals
1
1
Malt Cocoa Spread
1
1
Malted Pood
1
1
Malted Milk Tablets
1
1
Margarine ...'
4
4
Meat and Vegetable Extract
2
2
Milk
299
278
21
Deficient in milk fat 11
Added water 7
Dcf. in non-fatty solids 3
Mustard
1
1
Orange Fruit Wine ...'
1
1
Pepper
4
4
Petroleum JeUy
1
1
Porridge
1
1
Contained only 0.2% sage
and onion
Sage and Onion Stuffing
2
1
1
Sauce
3
3
Self Raising Flour
2
2
Soups
2
2
Spices
1
1
Spirits
17
16
1
Gin contained 30% adde 1
water
Sweetened Malted Choc. Pood
1
1
- ■
Sweetened Chocolate Spread
1
1
_
Tonic Wine
1
1
_
Vitamin “C” Tablets
1
1
Zinc Ointment
1
1
—
TOTALS
440
411 1
29
6.59% adulterated.
There were also 367 Gerber tests of milk during 1943, all of which were found
to be above the standard prescribed by the Sale of Milk Regulations, 1939.
12
PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND
OTHER DISEASES.
Table I at the end of the Report shows the number of cases of Infectious
Disease notified in each Sanitary District in the County.
Diphtheria. 225 cases with 12 deaths occurred during the year 1943
compared with 389 cases with 24 deaths during the year 1942. The disease
was more prevalent than it had been in the areas of Penzance Borough and
West Penwith Rural District, otherwise the incidence of the disease was much
less than for the previous two years. Relatively a much higher proportion
of the cases have occurred among adults and this is reflected in the admis-
sions to the County Isolation Hospital, where 48.7 per cent, of the cases of
diphtheria admitted have been adults. Diphtheria is normally a disease of
childhood. The low ratio of children to adults among patients sufiering from
this disease may be ascribed to the success of the immunisation campaign
among children in Cornwall; it might well have been that had such immunisa-
tion not been undertaken we should have had a grave epidemic of this most
serious malady.
Scarlet Fever. 229 cases with 2 deaths occurred during the year 1943
as compared with 228 cases with no deaths during the previous year Scarlet
Fever thus continues to be a very mild infection and it is doubtful whether
cases of this disease unless complicated require hospital treatment.
Enteric Fever. 7 cases with i death occurred during the year 1943 as
compared with 13 cases with no deaths during the previous year.
Cerebro-spinal Fever. 28 cases with 2 deaths occurred during the year
1943 as compared with 42 cases with 15 deaths during the previous year.
The treatment for this disease has been revolutionized in the last few years
by the introduction of the sulphonamide group of drugs. By the use of this
form of chemo-therapy the case fatality rate of this disease has been
strikingly reduced.
Measles and Whooping Cough. 1,918 cases of Measles with 4 deaths and
474 cases of Whooping Cough with 4 deaths occurred during the year 1943
as compared with 184 cases of Measles with i death and 696 cases of
Whooping Cough with 6 deaths in the previous year. It cannot too strongly
be emphasised that these infections, although they are commonly regarded
as trivial, are by no means always so, particularly in young children, and
not only lead to many deaths, especially from broncho-pneumonia but also
cause a not inconsiderable amount of chronic ill health among the survivors.
The provision of Isolation Hospital accommodation for these cases is thus
most desirable as skilled medical and nursing attention can greatly reduce
the risk to life and the likelihood of permanent ill effects.
County Isolation Hospital, Truro.
An order of the Ministry of Health making the County Council the
Isolation Hospital Authority for the whole of the County, with the exception
of the Borough of Saltash, the Urban Districts of Bude-Stratton and Torpoint,
and the Rural Districts of Stratton and St. Germans, came into operation
on the ist April 1943. This scheme had been submitted to the Ministry"
of Health by the County Council under sub-section (6) of section 185 of
the Public Health Act, 1936, and provides as follows: —
13
CORNWALL COUNTY COUNCIL.
PUBLIC HEALTH ACT 1936.
HOSPITAL ACCOMMODATION FOR THE TREATMENT OF
INFECTIOUS DISEASE.
SCHEME
Made on the 28th day of July, 1942, by the Cornwall County Council
after consultation with the Councils of all the County Districts in the County
under sub-section (6) of section 185 of the Public Health Act, 1936, for
altering the Scheme made by the Cornwall County Council under section 63
of the Local Government Act, 1929, on the 3rd day of December, 1934,
approved with modifications by the Minister of Health on the 9th day of
February, 1935, for the provision of Hospital Accommodation for the treatment
of Infectious Disease within the County of Cornwall (hereinafter referred
to as “the Principal Scheme”).
(1) Paragraph (i) of Part i of the Principal Scheme shall be varied as
follows: —
The Areas numbered i to 6 inclusive in the said paragraph shall be
combined into a single area, for which the required minimum number
of beds for patients shall be 90, and the accommodation shah be provided
by the County Council. Provided that, unless and until the County
Council provide a new Hospital for the purpose, the minimum number
of beds shall be no to be provided at the former Truro Public Assistance
Institution.
(2) The expenses incurred by the County Council for the purposes of this
Scheme shall be defrayed as expenses for special County purposes chargeable
on those County Districts mentioned in Areas i to 6 in the second column
of the Principal Scheme.
(3) This Scheme shall be construed as one with the Principal Scheme and
shall come into operation on the date which it is approved by the Minister
of Health.
The districts excepted from the Scheme are served, in the case of the
Borough of Saltash, the Torpoint Urban District and the St. Germans Rural
District by the Plymouth City Isolation Hospital. The Bude-Stratton Urban
District and Stratton Rural District continue to provide accommodation
for cases of infectious disease occurring in their areas in the Isolation
Hospital at Stratton.
The County Isolation Hospital is administered by the Isolation Hospital
Sub-Committee of the Health Committee and consists of 10 members of the
Public Health Committee and 5 members of the Local Authorities served
by the Hospital. The Medical Superintendent is the County Medical Ofl&cer,
and the Clinical Medical Officer is Dr. J. G. M. Molony.
Although it is housed in a building which is far from being ideal for
the purpose, the hospital has the great advantage that it is at all times
staffed by a team of Trained Nurses. The experience of the year has shown
that the decision to centralise the treatment of infectious disease in one
M
Hospital was fully justified. The appointment of a third ambulance driver
during the year enabled a 24-hour ambulance service to be maintained at
all times and has led to the elimination of delay in the removal of cases to
hospital.
A list of the cases of different diseases admitted to the County Isolation
Hospital is set out in Table II at the end of the Report, and shows the extra-
ordinary variety of cases which find their way into the hospital. The reason
for this is that the general practitioners in the county send in doubtful
cases rather than endanger the health and prospects of recovery of patients
by delaying admission to the hospital for treatment by waiting until
bacteriological confirmation of the disease has been obtained.
Westward Ho! Isolation Hospital, Newquay, used as an Emergency
Isolation Hospital under the Evacuation Scheme, and taken over from the
Newquay Urban District Council in April, 1941, continued to fill a useful
function throughout the year. It is primarily intended for cases of minor
infectious diseases. 130 cases were admitted during the year 1943 as com-
pared with 71 cases during 1942.
TUBERCULOSIS.
In the years before the present war an encouraging feature of our health
statistics was the steady fall, year after year, in the number of persons dying
from tuberculosis.
The reasons for this were many — improved housing, better economic
conditions, improvement in personal hygiene, an earlier approach to the
doctor for advice, and also better methods of treatment of the disease. As
was anticipated, the advent of war interrupted this favourable trend and has
led to an increased incidence of tuberculosis owing to overcrowding, over-
work and increased strain generally.
During the year 1943 there was again an increase in the incidence of
non-pulmonary tuberculosis, and in the number of deaths from this type
of the disease. Much non-pulmonary tuberculosis, especially in children, is
caused by the drinking of milk containing the tubercle bacillus, and much
crippling of young bodies as well as many deaths are the result. It cannot
too strongly be emphasized that Pasteurised ” milk is the only safe milk,
although “ Tuberculin Tested ” milk also is relatively free from risk of
infection. When supplies of milk to children, especially under the Milk in
Schools Scheme, are restricted to these types we may expect fewer new cases
of non-pulmonary tuberculosis.
The increased incidence of the disease during the year, together with
the continued limited availability of our normal beds for non-pulmonary
(orthopaedic) cases at the Royal Cornwall Infirmary, has led to an increased
demand for accommodation at Tehidy Sanatorium which it has been imposs-
ible to satisfy. There has consequently been in most cases a delay of some
weeks between the ascertainment of a case and the accommodation of the
patients in the Sanatorium. Efforts were made during the year to provide
temporary accommodation by obtaining and erecting wo^en huts, but
these efforts were fruitless, none of the huts being at all suitable for the
purpose,
L
15
The year saw the introduction by the Government of a system of
maintenance allowances for patients suffering from pulmonary tuberculosis.
The purpose of these allowances is to encourage patients who are suffering
from or suspected to be suffering from this disease, to give up their employ-
ment and enter a Sanatorium for observation or treatment. They are
conditional on the patients undergoing the treatment prescribed by the
Tuberculosis Ofi&cer, and are not intended to be given “ where treatment
cannot do more than alleviate a chronic condition.” This distinction between
the ” chronic ” type of patient who is ineligible for mantenance allowances
and the patient who may be expected in due time to return to work is a
clinical decision most difficult to make. It is invidious that for such a
purpose it should be made at all. It is also difficult to understand why
non-pulmonary ca.ses should be ineligible. Arrangements for the payment
of such maintenance allowances were put into operation on the ist August,
1943. Assessment of applications for such grants is undertaken by the
Public Assistance Officer and his staff, who, for this purpose, are regarded
as being on the staff of the Health Department and are called Social Welfare
Officers.
Maintenance allowances made to Tuberculosis patients during 1943: —
Number of persons receiving allowances ... 60
Average weekly grant ... ... ... 18s. 8d.
Total grant ... ... ... /i.iop 5s. 4d.
These allowances are reimbursed in full by the Ministry of Health.
On the same day as the maintenance allowances were introduced the
County.. Council abolished the payment of fees for accommodation at the
Sanatorium. Payment of fees by patients for accommodation at a Sanatorium
is undesirable for two reasons — first, it discourages them from staying a
sufficient time in the institution for treatment to be successful, and second
by reducing the family income the amount of money available for food is
diminished and hence malnutrition amongst other members of the family is
more likely to occur and they, especially as they have been contacts, are
more liable to fall victims to the disease.
It was decided during the year that a whole-time Occupational Therapist
should be appointed at the Sanatorium to organise the training and super-
vision of the patients in such activities as carpentry, leather work, basket
work, etc. The undertaking of such activities by patients is most valuable
in assisting their physical and also their mental recovery.
TEHIDY SANATORIUM
The following report on the County Sanatorium has been submitted
by the Medical Superintendent, Dr. Gaspey: —
A plaque in the front porch of the Sanatorium bears the following
inscription: —
THE MANSION PARK AND RESIDENCES OF TEHIDY
were purchased by a fund subscribed to perpetuate in a house
of benefit for living Comishmen and Cornishwomen a proud
memorial of their dead who in health laid down their lives
to defend their country.
1914 — 1918
i6
The tower of remembrance was erected by special subscription
in gratitude triumphant over death and difi&culty through the
divine mercy.
MAJOREM HAC DELECTIONEM NEMO HABET.”
The Sanatorium is situated three miles from Camborne and four miles
from Redruth, in the grounds of the Tehidy Estate. The Park is well
timbered, sheltering the Wards from most winds. The building consists of
part of the old Mansion, to which were added two new wings, eifter destruc-
tion of the centre part of the old Mansion by fire. This forms the admin-
istrative block of the Institution, as well as the Nurses’ Home and quarters
of the Domestic staff. There are four Pavilions or Blocks; tliere is one Block
for women (A Block) originally built for 20 patients; to this have been added
14 huts. Since the outbreak of war the Women’s Recreation Room has been
converted into a Ward and the entire Block now accommodates 45 patients,
including the 14 in huts. There are 3 Blocks for men, built in a straight
row on the north side of the administrative Block. C Block, opened in 1936
accommodates 20 patients; B Block of wooden construction, also has room
for 20 patients, and the War Memorial Block takes 12 patients. Since the
war 4 huts have been added at the end of this Block and by making full
use of all available room, it is possible to take 56 male patients. The Con-
servatory of the old Mansion has been arranged as a large ward, and is at
present occupied by children suffering from surgical tuberculosis. It is a
complete unit, quite separate from the rest of the Institution. Provision is
made here for about 20 — 22 patients according to the age of the children.
The Administrative Block contains on the ground floor the General
Office, Medical Superintendent’s Office, and Matron’s Office. There is also
a Laboratory, which was started in 1936 and is now fully equipped for all
bacteriological work undertaken at the Sanatorium. During the present
war the work of the Laboratory has increased, by reason of the fact that
it has become the County Laboratory, where all medical practitioners of the
County can send specimens to be examined in relation to tuberculosis. A
full time laboratory technician is in charge of this department under the
general supervision of the Medical Superintendent. The X-Ray Department
is well equipped with modem apparatus; in 1937 a Watson Rotalix Plant,
specially designed for chest radiography, was installed. In addition there
is a small unit for bone radiography. A dark room was constructed
adjacent to the X-ray room. The radiographs produced in the last few
years have been of the very highest quality. Also adjoining the X-ray
room is an Operating Theatre, equipped for minor chest surgery, and also
for emergency general surgery.
There is also a Dental surgery, an Ear, Nose and Throat Department,
and a Dispensary. In the same part of the building is a residential flat for
a Medical Officer. The first floor of the building is entirely occupied by
members of the nursing staff. In 1936 seven extra rooms were added in the
north wing. There are now 26 nurses’ bedrooms, together with Sisters’ Sitting
Room, and the Nurses’ Sitting Room and on the south side are the Matron’s
quarters. Adjoining the building facing east, are the Patients’ Recreation
and Dining Rooms. The Recreation Room contains a full size Billiard
table, and since Christmas 1935 has been used also for weekly cinema
performances. A 35 m.m. talkie apparatus was installed at Christmas 1935
L
and weekly performances have been very much appreciated ever since. The
installation of this cinema was made possible by the Richard Bolitho Fund.
The Recreation Room is also used on Sundays for religious services. The
patients’ Dining Hall and Nurses’ Dining Hall adjoin the Kitchen.
The Kitchen is very spacious. It contains 2 Esse and i Aga cookers,
large steamers for potatoes, and vegetable steamers. In 1938 a meat cutting
machine was acquired and this proved a great saving for two reasons; (a)
the meat is cut in thin regular slices and looks most appetising, and (b) the
saving in quantity as a result of the elimination of waste has been most
remarkable. In 1935 electrically heated food containers were installed, so
that food taken to the ward blocks is kept hot. A refrigerator was installed
and has been a great value in keeping butter and milk fresh.
The Institution has its own Laundry. To the original appliances was
added in 1937 a “ Glad Iron,” which is an electrically heated ironing
machine, used mainly for ironing nurses’ uniforms and white coats.
The Institution went over to the National Grid in 1937. Until that time
electricity had been produced by a small power station in the grounds.
Since 1937 the drains of the Institution have been connected with the main
Cambome-Redruth sewage system.
The Sanatorium is well provided with vegetables, from the old walled
gardens of the estate which produce excellent crops all the year round.
Since the war the lawns in front of the Institution have been ploughed up
and almost enough potatoes have been grown to supply our needs. It has
been our policy to keep pigs, and in pre-war days there were as many as 24,
but unfortunately we have had to reduce the number very considerably.
The staff of the Sanatorium consists of the Resident Medical Superin-
tendent, Matron, Assistant Matron, two Sisters, one Night Sister, one Ortho-
paedic Sister, four Staff Nurses, ten Probationer Nurses and two Male
Nurses, one Chef, and ten Domestics. There are also a General Clerk,
Medical Superintendent’s Clerk, Laboratory Technician, Sewing Woman,
Laundress and Assistant Laundress. ^The out-door staff consists of an
Electrical Engineer, a Plumbing Engineer, Carpenter, Painter, Head
Gardener, and seven Assistant Gardeners, a Woman Assistant Gardener and
a Boy.
Until 1937 the Dental Surgeon visited the Institution once a fortnight,
but when the number of beds increased to 108, Mr. Lean of Redruth was
appointed visiting dentist, and he now attends three sessions or more each
month. In 1937 Mr. Sheridan, was appointed as Ear, Nose and Throat
Surgeon. He visits the Institution once a month and each new patient is
examined by him and if necessary kept under observation or treated. Until
the year 1940 Mr. Panting of Truro was the Honorary Visiting Surgeon. Mr.
W. W. Rentoul became consulting Orthopaedic Surgeon in 1937 ^■nd at the
same time an Orthopaedic Sister was appointed. Mr. Rentoul visits the
Institution at fortnightly intervals and during the alternate weeks his assistant
Miss May sees the patients. On Mr. Panting’s resignation as Visiting
Surgeon, Mr. Donovan was appointed as his successor, but as he left during
the year Mr. Reid has taken his place.
A very interesting appointment was made in 1939, when Mr. N. R.
Barrett, became Chest Surgeon to the Institution; since then minor chest
surgery such as phrenic evulsions and thoracoscopies have been performed at
i8
the Institution, and arrangements were made for major chest operations (for
the time being), to be done at Horton Emergency Hospital, Surrey. As a
lesult of this appointment there has been an improvement in the methods
and results of surgical treatment of cases of pulmonary tuberculosis admitted
to the Sanatorium, especially in the case of patients treated by artificial
pneumothorax. The results of treatment at Horton Hospital also have been
highly satisfactory, particularly in view of the fact that most of the patients
sent there would have had little prospect of recovery if treated only by
ordinary Sanatorium methods.
A School was established in the Children’s Ward in 1939, when Mrs.
Bailey of Redruth was appointed teacher. This school was eventually
recognised by the Board of Education and has been a great success and
helped tremendously towards improving the general outlook of the children.
To my knowledge those children who have left have been found to be well
up to standard when going to the ordinary schools.
It was my privilege in 1936, to establish a Canteen; this was such a
success that the building had to be doubled in size after a very short time.
In pre-war days it was well stocked. Now of course we have our difficulties,
but manage to keep going surprisingly well. The Canteen is well patronised
by both patients and staff. A patient is usually in charge and all profits
go to a ” Samaritan Fund,” which gives help to any patient who may
be in need.
The Clerk of the Institution, Mr. H. Whitford, joined the Forces in 1942
and his wife has taken his place for the time being. As the work in the
office has increased during the last few years, and especially during the war,
because of numerous regulations and forms which have to be completed, the
work has been divided by appointing a Secretary to the Medical Superintend-
ent to attend to the medical correspondence.
Other members of the Staff who have joined the Forces are: —
F. Haines, carpenter; F. Woodmason, painter; W. Northey and S.
Matthews, stokers; Stanley Stephens, gardener. I regret to have to report
that Stanley Stephens was killed in a flying accident in 1943.
All types of cases of tuberculosis are admitted to the Institution. On
the pulmonary side early as well as advanced cases are treated. The
Memorial Block and the Huts on the women’s side have been reserved for
those patients who are up and about all day.
REPORT OF MEDICAL WORK CARRIED OUT AT TEHIDY
SANATORIUM DURING THE YEAR 1943.
Admissions.
During the year 173 patients were admitted, 138 were discharged and
23 died in the Institution.
Treatment.
The main principle of treatment has been to give an initial period of
complete rest. During this time an endeavour is made to assess the patient’s
condition by study of symptoms and signs including temperature and pulse
rates, by physical examination, x-ray examination, sputum tests, blood
tests, etc., and then to determine the treatment which is most likely to benefit
the individual. Complete or partial rest may be continued, and some very
19
gratifying results have been obtained in cases where patients were immobil-
ised completely for a period of from 9 to 12 montlis on a plaster bed.
Satisfactory results have also been obtained by artificial pneumothorax.
A.P. was induced in 52 cases, and successfully maintained, with benefit to
the patient in 43 cases. Unsatisfactory A.P. were abandoned in 9 cases,
and induction attempted unsuccessfully in ii cases.
Some artificial pneumothorax cases required further treatment, because
of adhesions, and were seen by Mr. Barrett. In 24 cases thoracoscopy
permitted cauterisation of all or part of these adhesions, with improved
collapse of the lung. It is most unfortunate that owing to war conditions
Mr. Barrett has had to curtail the number of his visits, as it is probable that
many patients would benefit by further surgical interference. Phrenic nerve
evulsions were performed on 16 patients, in most cases as a preliminary to
abandoning the A.P. on cornpletion of treatment.
P'urther work in the theatre consisted in removal of fluid from the
pleural cavity, with or without gas replacement on 430 occasions. 254
injections of Gold Salts were given, but the results have not been as good
as was hoped.
Statistics of Refills.
Number of Refills given: —
In-Patients ... ... ... ... 699
Out-Patients ... 307
Total ... 1,006
These refills are given at regular intervals. Tuesday mornings are
specially reserved for Out-Patients; most of these cases require careful
supervision by X-ray screening.
Examinations.
Patients are examined for physical signs at intervals of 5 weeks, have
their sputum and blood tested, and X-ray pictures taken so that progress
may be checked.
Clinical re-examination of In-Patients ... ... 806
Clinical re-examination of Out-Patients ... ... 102
Examination of New Patients ... ... ... 173
Total ... 1,081
Laboratory Work.
Sputa
Sanatorium patients, by direct method ... ... 798
Sent by Medical Practitioners by direct method 537
Culture Tests ... ... ... ... ... 48
Total ... 1,383
Examination of sputa submitted for examination by medical practitioners
in the County, commenced on ist July, 1943.
20
Other work in the Laboratory consisted of: —
Blood Sedimentation Rate Estimations 902
Blood Counts ... ... ... ... ... 20
Urine Examinations ... ... ... ... 194
Dental Department.
Examination of new patients .... ... ... 125
Re-Examination of In-Patients ... ... ... 26
Number of Patients to have extractions with
Local Anaesthetic ... ... ... ... 72
Number of Patients to have extractions under
General Anaesthesia (Nitrous Oxide) ... 20
Number of Fillings ... ... 31
Many of these patients have been fitted with dentures. The Canteen
“ Samaritan Fund ” has been of great help on several occasions when
patients have been in need of financial help to purchase these dentures.
Ear, Nose and Throat Department.
All new patients are examined by the Throat Specialist, and those cases
under observation and treatment by him are seen at monthly intervals.
Patients treated at Horton Emergency Hospital.
Patients sent to Horton Hospital lor thoracoplasty ... 1 1
Patients returned from Horton Hospital ... ... 6
Died in Horton Hospital ... ... ... ... i
It has been possible -in spite of great difficulties, thanks to extra work
put in by, at times, sadly depleted staff, not only to keep all beds occupied,
but even to have as many as 12 additional patients. Several times it was
thought that a Ward would have to be closed owing to shortage of staff,
but thanks to help from Civil Nursing Reserve nurses and nursing auxiliaries
we have managed to keep going. We have also had difficulties with domestic
staff, due partly to the fact that the Institution is rather isolated, and to
dif&culties of transport.
A further problem has been tliat of washing up after meals. As at times
only a small number of patients are up all day, these have to do a large
amount of washing up 4 times daily, and this has led to discontent which it
has not always been easy to overcome.
A small second hand motor van was purchased during the year, for
internal transport to help to solve the problem of staff shortage. Both
patients and food can be taken to the Blocks from the main Building.
A Patients’ Committee has been formed to meet Matron and myself
to try and solve problems created by food rationing, or difficulties in cooking.
This Committee is now also being interviewed every other month by a Sub-
Committee of the Tuberculosis Committee.
The Cinema shows have been well attended as usual.
There was generous help in the form of money and clothing from many
individuals and organisations at Christmas. All donors were thanked.
The Climax Entertainments Committee gave a concert at Redruth to
provide the Laboratory with a new Microscope, and I wish to express my
gratitude to the organisers.
31
An appeal to the “ Readers Union ” for books, brought gifts of volumes
from all parts of the Country.
/
I would like to express my thanks to Mr. Fox for the support he has
given me during his 8 years as chairman, and the great interest he has
always shown in the affairs of Tehidy.
My thanks are due also to the Matron, Nursing Staff, and the members
/ of the staff for the support they have given me during the year, and the
excellent way they have performed their duties.
I ' i
Apart from the County Sanatorium, there are Tuberculosis Treatment
Centres at Penzance, Tuckingmill, Truro, St. Austell and Liskeard. A
table showing the work done at the Treatment Centres is given at the end
of the Report (Table III) .
The Tuberculosis Officer, on receipt of a notification, informs the notify-
ing practitioner that he proposes to follow up the notification unless the
practitioner reports that there are special reasons why this should not be done.
m
No action has been taken under the Public Health (Prevention of Tuber-
culosis) Regulations, 1925 (relating to persons suffering from Pulmonary
Tuberculosis employed in the milk trade), or under Section 172 of the Public
Health Act, 1936 (relating to the compulsory removal to hospital of persons
suffering from Tuberculosis) .
22
The following Table shows the cases actually diagnosed as tuberculosis
by the County Tuberculosis Officer: —
NEW (DEFINITE) CASES.
Year
Pulmonary
Noil-Pulmonary
Pulmonaiy
and Non-
Pul monary
c
V
C/)
(A
V
XT.
(0
V
s
o
O
03
"u
o
Total.
V
S
E
o
>
>>
C
03
"u
o
Tota
Total
1926
136
93
7
3
239
18
18
14
11
61
I
300
1927
111
89
7
8
215
9
. 16
16
6
47
262
1928
106
105
10
5
226
11
11
12
6
89
265
1929
no
88
8
8
204
12
17
7
6
42
246
1930
94
92
3
7
196
18
12
18
2
40
236
1931
107
96
4
6
211
9
10
4
4
27
238
1982
102
92
8
8
200
8
16
8
7
88
288
1983
103
78
—
7
188
13
7
2
2
24
207
1934
91
74
1
4
170
12
18
7
8
45
215
1936
87
51
2
—
140
8
10
4
4
26
166
1936
77
66
1
4
148
7
6
4
2
18
166
1937
79
60
6
8
148
12
4
6
1
22
170
1938
92
56
3
—
151
17
11
8
6
42
193
1939
74
64
8
3
144
10
18
8
10
41
186
1940
93
68
6
2
168
10
6
6
9
-30
198
1941
97
68
1
6
171
9
6
11
10
86
207
1942
126
68
2
3
189
7
5
9
6
26
216
1943
104
67
2
3
176
10
18
11
8
42
218
*3
New Cases and Mortality during 1943.
New Cases Notified.
Deaths.
Age Period.
i’ulinonary
Noa-Puluiouary.
Piihiionary
Non-Piilu)oiiai
M.
F.
M. F.
M.
F.
M.
F.
0 — 1
—
—
— I
—
I
3
—
I— 5
2
I
3 5
—
—
3
6
5—15
3
2
10 9
I
2
3
I
15—45
106
73
14 II
41
36
9
12
45—65
42
12
2 2
45
15
4
3
65 and upwards
4
2
— I
7
7
I
I
—
. ...
—
--
—
—
Totals
157
90
29 29
94
61
23
23
—
—
—
—
—
—
247
58~
305
155
46
201
The notifications of non-pulmonary
tuberculosis wi:re
as follows
: —
1939
1940
1941
1942
1943
Bones and joints
26
23
24
10
18
Glands
9
9
16
20
17
Meninges
7
8
4
7
9
Abdomen and peritoneum
3
5
3
17
9
Kidneys and Bladder
4
2
4
I
4
Others ...
2
2
2
2
I
51
49
53
57
58
Number of Cases receiving treatment in Residential Institutions on 31.12.43.
Kx-servicp
(accepted
cases)
Pulmonary
Non-Pulmonary
Total
Non-
Pulm
Pnlm.
M
F.
Oh.
M
F.
Ch.
Institutions belonging
to Authority
Institutions belonging
31-^
—
24
41
2
1
1
20
120
to other Local Author-
ities
2
—
2
5
' '
1
2
1
13
Voluntary Institutions
—
2
2
1
—
6
4
7
21
Total
83
2
28
47
2
7
7
28
164
*Including 3 Women.
V
24
VENEREAL DISEASES.
Treatment Centres: (i) Royal Cornwall Infirmary, Truro, (2) Tucking
mill, near Camborne, (3) The City Hospital, Plymouth. All Treatment
Centres in the Country are open to all comers.
Summary of Work done; —
Treatment Centre at
Plymouth.
(Patients from Cornwall
only).
Treatment Cenirk
AT TuCKINQMILL.
Treatment
Centre at Truro
1940
1941
1942
1943
1940
1941
1 1942
1943
1910
1941
1942
1943
No. of Persons dealt with at
the out-patient Dept, for the
first time and found to be
suffering from : —
Syphilis
4
8
10
8
13
38
40
39
69
225
331
408
Soft Chancre
1
1
2
—
1
—
1
1
2
7
9
14
Gonorrhoea
12
11
13
8
25
40
38
51
116
239
210
229
Conditions other than
Venereal
18
13
19
53
10
17
23
29
83
i:30
300
491
’Totnl
35
33
44
69
49
95
102
120
270
651
850
1162
Total No. of attendances at
the out-patient dept.
546
415
532
610
529
562
700
909
2083
4138
5223
6989
Aggregate No. of in-patient
days
397
89
253
255
■-
—
—
—
990
2415
2464
1867
No. of doses of .Arsenoben-
zene Compounds given.
(Out-patients and
In-patieuts.)
111
87
170
104
176
237
285
421
748
1810
2803
.J
2887
Examination of pathological
material at the Treatment
Centre or sent to an ap-
proved laboratory for —
Detection of Spirochetes
21
73
81
215
,, Gonococci
137
92
188
186
44
60
73
97
272
1
636
423
888
Wassermunn reaction
62
61
83
90
59
77
75
97
164
449
855
1308
Others
19
14
32
46
38
69
49
77
149
215
785
1191
Total
218
167
303
322
141
206
197
271
606
1373
2144
3602
Summary for Cornish Patients.
New cases
Total attendances at Clinics
Specimens examined
1937.
1938.
1939.
1940.
1941.
1942.
1943.
219
222
279
354
779
996
1,351
2,090
2,121
2,439
3,158
5,115
6,455
8,508
559
708
923
965
1,746
2,644
4.195
25
It must be noted that the total attendances under the Rural Practitioners
Scheme were 435 in the year 1942 and 1,637 19431 ^ truer
picture of the increase in Venereal Disease may be obtained by adding these
attendances to the attendances at Clinics. The corresponding totals for the
2 years wiU then be 6,890 and 10,145 respectively.
The following shows the number of new cases at the Treatment Centres
actually found to be suffering from venereal diseases: —
1920. 1922. 1926. 1930. 1935. 1939. 1940. 1941. 1942. 1943.
166 75 102 144 122 188 243 619 654 778
It will be noted from these Tables that there has been a steady
increase in the amount of Venereal Disease in this County since the outbreak
of War, this increase having affected more particularly Syphilis, which has
increased by about 25 per cent, as shown by the number of new cases dealt
with at the Treatment Centres during the year. Gonorrhoea has increased
by about 10 per cent.
The new cases of non- venereal disease dealt with at the Treatment
Centres show an increase of about 66 per cent, on the preceding year, and
this may be taken as some indication of anxiety among the general public
resulting from the increased incidence of venereal disease, and from the
increased awareness of the public which has arisen from the Ministry of
Health’s propaganda on the subject.
Regulation 33B, which enables Special Medical Practitioners formally
to notify the alleged source of infection in proved cases, and which permits
the institution of compulsory examination of a person alleged to have infected
two other people, continued to operate during the year; 41 notifications were
received, 6 persons being the subject of a double notification.
The Rural Practitioners Scheme, which began in July 1941, and provides
treatment for Venereal Diseases at the surgeries of 8 medical practitioners
with special skill and experience in the treatment of these diseases, was
continued during the year. As mentioned above, 1,637 attendances were
made by patients under this Scheme in 1943 as compared with 435 in 1942.
Five beds are reserved at the Royal Cornwall Infirmary Truro, for cases
requiring in-patient treatment. Arrangements are made for new cases to be
seen there at any time. The Pathological Department of the Royal Cornwall
Infirmary, under the direction of Dr. F. D. M. Hocking, has been approved
by the Minister of Health for the examination of specimens from persons
suffering, or suspected to be suffering, from Venereal Disease. The necessarv
outfits and directions are supplied to medical practitioners by Dr. Hocking.
CANCER.
The Cancer Act 1939 requires every County and County Borough
Council to provide facilities for the treatment of persons within their area
suffering from cancer. The date before which schemes under this Act had
to be submitted by Local Authorities to the Ministry of Health was postponed
until 31st March, 1944, and accordingly during the year under review a great
deal of work was undertaken in the preparation of this Scheme. It has been
recommended by the National Radium Commission that the area to be
served by a Cancer Organisation should be of such a size that not less than
1,000 cases are treated in a year. Such a number can be expected from a
population of 1,000,000 and the Radium Commission accordingly recom-
26
mends that this should normally be the smallest number of persons for
which a Cancer Organisation should be established. Thus it will be seen that
Cornwall by itself has too small a population to run an independent Cancer
Organisation and therefore it is necessary for this County to join with the
County of Devon and the County Boroughs of Plymouth and Exeter to form
one joint scheme. The Scheme which is set forth below was adopted by the
County Council durinjj the year, and later, as required by the Act, consulta-
tions were held on the proposals with representatives of the governing bodies
and the medical and surgical staffs of the voluntary hospitals in the County
and of the British Medical Association. As a result of these consultations
certain modificcftions of the Scheme were introduced, and the Scheme as
amended and accepted by the four constituent Local Authorities is as
follows: —
CANCER ACT 1939.
Draft Scheme for certain areas in the South West.
1. The Authorities to take part in the joint scheme will be the Counties
of Devon and Cornwall and the County Boroughs of Exeter and Plymouth.
Such a joint scheme would cover a population of approximately 1,000,000.
2. The Councils referred to in the preceding paragraph will arrange
to secure all necessary facilities so that every person in the two Counties and
the two County Boroughs who is, or is suspected to be, suffering from cancer
may obtain advice and that every such person who is found to be suffering
may obtain adequate treatment.
3. This Cancer Organisation will have its Administrative Centre at
Plymouth.
4. Arrangements will be made for utilising the facilities for diagnosis
and treatment (both surgical and radiotherapeutic) at " clinical centres ”
viz: — Exeter (Royal Devon and Exeter Hospital); Plymouth (City General
and Prince of Wales Hospitals) ; Torquay (Torbay Hospital) ; Redruth
(Camborne-Redruth Miners’ & General Hospital) and the Royal Cornwall
Infirmary, Truro (for surgery only) . Certain members of the staff of each
of these hospitals, nominated by the Medical Advisory Committee referred
to in Clause 10 or suggested by Hospital Managements and appointed by the
Joint Committee under Clause 5, will be members of the Cancer team and
only such members will take part in these arrangements. Patients will
thereby not be required to travel unnecessarily long distances to obtain
advantage of the scheme. Other diagnostic and treatment centres may
from time to time be included in the Scheme if the Joint Cancer Committee
so decide.
5. The principal member of the Cancer Team will be a whole-time
Director with a wide experience of cancer. He will work from the hospital
which is the Administrative Centre and he will be in control of the arrange-
ments made under this Scheme for the diagnosis and treatment of cancer.
The Director will be responsible to the Joint Cancer Committee referred
to below. The remainder of the Team will consist of physicians, surgeons,
gynaecologists, radiotherapists, radiologists, pathologists and physicists,
appointed by the Joint Cancer Committee who will consider any representa-
0
27
tions which may be made to them by Hospital Managements or any nomina-
tions submitted to them by the Medical Advisory Committee to be appointed
under Clause lo of tliis scheme.
6. Arrangements will be made for examination of pathological specimens
in all cases where necessary at Plymouth, Exeter, Truro and Torbay.
7. Arrangements will be made for the payment where necessary of
travelling expenses of patients (including where necessary the expenses of a
companion) incurred by persons in availing themselves of the services pro-
vided. Hostel arrangements will be made when patients are required to
be away from home overnight.
8. Records will be kept in such form as the Minister of Health may
approve.
9. The Councils will by such means as appear desirable give such
publicity to these arrangements as they may think necessary for bringing
them to the notice of persons to whom they may apply.
10. The administration of the scheme will be carried out by a Joint
Cancer Committee composed of representatives as follows: —
C.B. Exeter, 3; C.B. Plymouth, 4: County of Cornwall, 5: County of
Devon, 6; and in an advisory capacity the Chairman of the Medical Advisory
Committee or his Deputy and the Medical Officer of Health together with
such other principal ofiicers of each of the four Councils as may be necessary.
Co-option of persons with special knowledge or interest will not exceed a
total of 4 persons and will be terminated annually, but will be renewable.
The Joint Cancer Committee shall appoint a Medical Advisory Committee to
whom they shall from time to time refer medical matters of importance
for consideration and report.
11. The net cost of the Scheme will be borne by each of the four
Councils in such proportion as shall be decided hereafter.
This Scheme was submitted to the Ministry of Health early in 1944.
656 deaths occurred from Cancer during the year 1943 as compared witli
644 during the year 1942 and 643 during the year 1941.
BLIND PERSONS.
There are 5 Home Teachers, four sighted and one blind. These work
under the County Blind Association and visit the homes of blind persons and
teach Moon and Braille reading, and otherwise keep under observation all
blind persons who wish to be visited. There are 17 blind Home Workers
in the County.
Prevention of Blindness. The Council have adopted a system of volun-
tary notification by medical practitioners of persons threatened with blindness.
There were 798 registered blind persons on 31st March, 1944, 309 males
and 489 females, a decrease during the 12 months of 17. 57 new cases were
28
registered during the year 1943. The following Table shows the age groups
of blind persons: —
Number of Blind Persons in Age Groups Ages at which Blindness occurred.
Age Period.
Number.
Age Period.
Number.
0 — I
—
0 — I
71
I— 5
2
I— 5
7
5—16
10
5—10
24
16 — 21
13
10 — 20
34
21 — 40
42
20 — 30
46
40—50
54
30—40
59
50—65
156
40—50
85
65—70
94
50 — 60
151
Over 70
427
60 — 70
151
Over 70
170
Total
798
Total
798
Blind Children of School Age, 5 — 16
Normal.
Mentally
Deficient.
Physically
Defective
Total
In Schools for the Blind ...
5
—
—
5
Other Schools
—
—
—
—
Not at School
I
4
—
5
—
—
—
—
Total
6
4
—
10
Training and Employment (Age period 16 and upwards).
Employed —
By Blind Organisations
(a) Workshops ... —
(b) Home Workers ... 17
All others not included in (a) or (b) 104
Total employed 12 1
Undergoing Training —
Industrial ... 2
Secondary ... 2
Professional or University ... —
Total undergoing training 4
Unem ployable ... 661
Total
786
39
Physically and Mentally Defective (all ages) .
(a) Mentally Defective ... ... 33
(b) Physically Defective ... ... 44
(c) Deaf 35
(d) Combination of (a) and (b) ... 9
(e) Combination of (a) and (c) ... 6
(f) Combination of (b) and (c) ... 5
(g) Combination of (a), (b), (c) ... 3
Total 135
Unemployable persons resident in Homes for the Blind, Mental Hospitals,
or Poor Law Institutions.
Homes for the Blind
5
Mental Hospitals
20
Poor Law Institutions
32
Total
57
VACCINATION.
The following is a summary of returns showing the number of certificates
and Statutory declarations received by Vaccination Officers during recent
years, relating to children whose births were registered during the preceding
year: —
No. of
Success-
Insus- Statutory
Died
Postpone-
Removed Removed
Not
Year.
births.
fully
ce.ptiblc declarations unvacc-
ment by
to other
to places
account-
Percentage
(Preced-
vacciu-
of vacc- of conscien-
inated.
Medical
Districts
unknown.
ed for.
of births
ing
ated.
ination. tious
Certificate.
vaccinated.
year).
objections.
1940
3.955
601
7 2,780
149
22
77
139
180
15-19
1941
4.630
831
^4 2,831
144
25
154
407
224
17-95
1942
5.205
1,102
16 2,748
176
32
274
622
335
21.17
1943
5.066
1. 321
22 2,452
151
36
276
446
362
26.07
MATERNITY AND CHILD WELFARE.
Area. The County Council is the Supervising Authority under the
Midwives Acts for the whole County, but for other Maternity and Child
Welfare work the Boroughs of Penzance and Falmouth are separate
Authorities. (These Boroughs are also separate Education Authorities).
County Maternity Unit. (33 beds). The County Maternity Unit is main-
tained by the County Council at the Camborne-Redruth Miners’ and General
Hospital under an agreement with the governing body of that hospital. As
mentioned below the Emergency Maternity Home at Hayle was closed on
the 25th February, 1943. This Home had been set up under tlie evacuation
30
scheme and a certain number ol County cases had been dealt with there,
it was stated in the last Annual Keport that the County Council’s maternity
accommodation at tlie Aedrutb Hospital was already working to capacity,
and the demand tor matermty ueds continued to mcrease during the early
part of 1943; these tacts coupled with the /ilosure ot the Hayle Maternity
iiome rendered an increase ot accommodation at Kedruth imperative,
and it was then that the hospital adapted tor this purpose “ 'Irewirgie
Corner,” a large private house situated some 540 yards to the E.S.E. ol
the hospital. By this addition the accommodation at the Council's maternity
unit was increased to a total ol 33 beds. ” 'Irewirgie Corner ” was opened
on the 25th February, 1943.
During the year 458 patients were admitted to the Unit as a whole,
these included a great variety ot abnormal cases drawn from ail parts ot
• the County. 427 Dabies were born, including 8 pairs ol twins and one set
ot triplets, all the triplets surviving. Ot the admissions just over 40% were
primigravidae. 40% ot all admissions were emergencies, 11% were ante-
natal cases, and 4% were post-natal cases, the remaining 45% being
normal booked cases. 'Ihere were 35 stillbirths and 10 neonatal deaths.
Ihere were 4 maternal deaths; this was a notably small number, especially
so having regard to, the uicreased work carried on at the Unit during the year,
and should be considered in the light ot the tact that the County’s maternal
mortality reached a record low level in 1943.
9 patients were delivered by Caesarean Section, and no less than 16
patients who had had Caesarean Sections on former occasions dehvered
themselves naturally. Ilie average bed occupancy for the year at the
Maternity Ward in tlie Hospital was 20.1, the maximum number of patients
during any one day being 26 and the minimum number 9. 'Ihe corres-
ponding figures for ” Trewirgie Corner ” were 13.01, 22 and 8.
Once again it will be seen that available maternity accommodation was
working to capacity, frequently passing this point, and tlirowing a great
strain on the stall in making provision for the flow of abnormal maternity
cases which must be taken, frequently at very short notice, at any time
of the day or night, and which can never be refused.
County Maternity Home, Bodmin. (12 beds). This home ceased to be
an Emergency Maternity Home on the 30th June and became a County
Maternity Home. 174 babies (including 2 pairs of twins) were born; there
were 4 stillbirths and 2 neo-natal deaths. 'Ihere \vere 10 forceps dehveries
(5.8% of the total). Approximately 47% of the deliveries were first births.
Emergency Maternity Homes.
(a) Hayle. (15 beds). As mentioned above this home was closed on
the 25th February. In the two months of 1943 during which it was open
18 patients were delivered without incident.
(b) Looe. (18 beds). 196 babies (including 2 pairs of twins) were
born; there were 1 stillbirth and 2 neo-natal deaths. There were 9 forceps
deliveries (4.6% of the total). Approximately 41% of the deliveries were
first births. As before, the majority of patients at Looe came from Plymouth.
31
It will be seen that 815 births took place in the County Council’s
maternity accommodation during 1943, this being 16.4 per cent, of the
County’s total births in that year, the corresponding figure for the preceding
year is 15.4.
Other Maternity Beds. In the Institutions transferred to the County
Council under the Local Government Act, 1929, there are 14 maternity
beds, to which 40 women were admitted during the year.
Rosemundy Home, 19 beds, for unmarried girls, is maintained by the
Cornwall Social and Moral Welfare Association. The girls are usually
retained for one year.
Consultants. A second opinion was obtained by medical practitioners
for II patients under the Council’s scheme, in addition to consultations
with the County Obstetrician.
Ante-natal and Post-natal Services. The Council has arrangements under
which a midwife may obtain for each of her patients two ante-natal examina-
tions and one post-natal examination by a medical practitioner, and 980 such
examinations were made in 1943.
Ante-natal Clinics. The ante-natal clinics which the Council opened
in March of last year at St. Austell, Liskeard, Looe, Launceston, Bodmin,
Newquay, Redruth and Hayle were continued each week, with the County
Obstetrician in attendance. The average attendances continued to increase
and the figures, together with the percentage of new cases, for each cUnic
for the last quarter of the year are as follows: —
Average
Percentage of
Clinic.
Attendances.
new cases.
St. Austell
II
19
Liskeard
5
8
Looe
4*
20
Launceston
6
15
Bodmin
14
16
Newquay
7
13
Redruth
26
17
Hayle
8
18
*In addition to patients in the Ante Natal Hostel.
Place of Birth. The increasing tendency for women to seek institutional
confinement has been a prominent feature in recent years. In Cornwall the
situation has been complicated by the Evacuation Scheme and the setting
up of the Emergency Maternity Homes; the official evacuees have been
frequently in billets in which confinement is virtually impossible and women
who have evacuated to the County under private arrangements have often
been in addition persons more prone than are the Cornish women to look
upon institutional confinement as the normal thing. Nevertheless, the matter
is one worth keeping under observation, and'the following figures, which
apply to births notified as occurring in the County Council’s area as Welfare
Authority, are of interest: —
32
Percentage of Births occurring in Various Places.
Other
Hospitals &
County Public
Emergency Maternity County Maternity Assistance
Patient’s
Nursing
Homes & County
Maternity
Ward Annexe,
Institu
own Home.
Homes.
Maternity Home,
Ward,
“ Trewirgie
tions.
Year.
Bodmin.
Eedruth.
Corner. ' ’
1941
65.2
15-7
9.9
5-7
—
3-5
1942
63-4
i6,.5
12. 1
4-5
—
3-5
1943
58.5
21.7
8.7
4.6
3-25
3-25
Home Helps. During the year a Scheme was inaugurated for the employ-
ment of Home Helps in homes for women at the time of their confinement.
Although this Scheme is at present in its early stages, it is hoped that it will
develop into a most useful service.
Residential Nurseries.
1. Perranporth Residential Nursery. (22 beds). This Nursery continued
its useful work; 42 children were admitted, bringing the total admissions
since the opening of the Nursery in 1941 to 206.
2. The Health Department continued to provide general medical super-
vision for the three L.C.C. Nurseries at Looe, Carbis Bay and Newquay,
and for the two “ Save the Children ” Fund Nurseries at Redruth and Looe.
Again, a considerable amount of epidemiological work was carried out.
War-Time Nurseries.
The four day nurseries at St. Austell, Camborne, Newquay and Polzeath
were continued, the average daily attendances for the year being respectively
26, 12, 18 and 20 and the maximum attendances on any one day being
respectively 41, 33, 35 and 33.
Midwifery.
Number of births in the
County
Number attended by Mid-
wives acting as Midwives
Number attended by Mid-
wives acting as Maternity
Nurses
Total attended by Midwives
in either capacity
1914.
6,413
1,690(26.35%)
1,089(16.98%)
2,779(43-33%)
1942.
5,126
3,016(58.83%)
1,657(32.32%)
4,673(91.16%)
1943-
5,134
2,919(58.85%)
1,968(38.33%)
4,887(95.18%)
Medical help was sent for by Midwives in 39.94% of their cases as com-
pared with 43.96% for 1942 and 52.23% for 1941.
REPORT OF THE SUPERVISOR OF MIDWIVES.
Total number of midwives who have notified their intention to practise
during the year 1943 is 260.
Number in practice on December 31st, 1943
231
33
Available for work as follows: —
Domiciliary
Nursing Homes
Institutions
Total
i86
25
20
231
Of the Domiciliary Midwives: —
Work under the Cornwall County Nursing Association 152
Under Independent Association
...
I
In private Practice
33
Total
186
The Domiciliary Midwives working under the Cornwall Nursing Associa-
tion are of 3 classes: —
Village Nurse Midwives
...
112
S.R.N. and S.C.M.
... ...
21
Queen's Nurses, S.R.N. S.C.M. and District Training ..
19
Total
152
Cases attended by Midwives in different
groups: —
As Midwives
As Maternity
Nurses.
Cornwall County Nursing Association
1,683
1,099
Independent Association
47
41
Institutions (County Maternity Unit and Homes) 749
61
Nursing Homes and Public Assistance Institutions 396
698
Private Practice
44
69
Total
2,919
1,968
During the year 487 visits were paid in
addition to 278 special visits of
enquiry; an average of 3 visits to each practising midwife.
As Midwife.
As Maternity
Notifications Received.
Nurse.
Cases Attended
2,919
1,968
Stillbirths
42
—
Death of Mother
4
I
Death of Child
22
Artificial Feeding
92
—
Liability to be Infectious
70
—
Number of Times Medical Aid Sought.
For Mother —
1942.
1943
During Ante-natal period
275
262
At Labour
766
659
During Puerperium
120
90
For Child
165
155
1,326 1,166
34
Of the 42 stillbirths: —
Full term
28
Premature
14
Macerated
23
Deaths of Infants.
Of the 22, 5 were premature.
Maternal Deaths.
Of tlie 4 maternal deaths, 2 occurred in
Hospital and 2 at home, the
causes of death being certified as follows: —
Phlebitis and Pylitis
Coronary Embolism
Gas Gangrene
Puerperal Insanity.
There was also one maternal death in which the midwife was acting
as maternity nurse.
Liability to be a source of Infection.
Of the 70 cases notified; —
Rise of temperature
44
Discharging Eyes
6
Rash
3
Illness of Nurse
2
Other Causes
15
Puerperal Pyrexia.
Of the 55 cases: —
Midwives’ cases at home
13
Doctors’ cases at home
8
Occurred in Nursing Homes
7
Occurred in County Maternity Ward
27
Of the 21 cases delivered at home, g were
admitted to Hospital and 12
were nursed at home.
Of the 7 cases delivered in Nursing Homes,
4 were admitted to Hospital.
Maternal Mortality. There were 7 deaths from Sepsis and 6 from other'
causes connected with child bearing, maldng a total of 13 deaths. The follow-
ing are the rates per 1,000 births, including still births, in recent years.
Sepsis.
Other
Total
England
Causes.
Cornwall.
Wales,
1919-22
0.76
3.26
4.02
—
1924
0.58
2.12
2.70
3-90
1925
1.82
5-05
6.87
4.08
1926
0.62
2.47
3-09
4.12
1927
1.27
3-17
4.44
4.11
1928
1.71
3.86
5-57
4.42
1929
1.94
3-24
5.18
4-33
1930
0.86
3-87
4-73
4.40
35
Sepsis.
Other
Total
England &
Causes.
Cornwall.
Wales.
1931
0.85
2.78
3-63
3-94
1932
0.87
2.85
3-72
4.06
1933
1.81
2.72
4-53
4-23
1934
1.81
4.09
5-91
4.41
1935
0.68
3-88
4-57
3-93
1936
1. 14
2.75
3-89
3-65
1937
0.48
3.12
3.60
3-II
1938
1.42
332
4-74
2.97
1939
0.72
2.62
3-34
2.82
1940
0.22
2.18
2.40
2.16
1941
1. 13
3.20
4-33
2.23
1942
0.39
1.56
1-95
2.01
1943
1.36
1. 17
2.53
2.29
The rates for particular years are very variable owing to the compara-
tively small number of birtlis. The following are tlie rates for recent five
year periods: —
1924-28 ... 4.53
1929-33 ••• 4-36
1934-38 ... 4.54
1939-43 ••• 2.91
In comparisons with the rest of the country it is wise to use the quin-
quennial figure for Cornwall, as a rate such as this which depends on a small
figure of actual deaths is liable to fluctuate violently and the general trend
is difficult to follow. Using then the quinquennial rates for maternal
mortality, the number of deaths in the five year period 1939/1943, had the
maternal mortality rates of 1914/1918 applied, would have been 115, whereas
in fact only 71 mothers lost their lives during these years for reasons
connected with childbirth.
Infant Mortality.
Infant mortality rates: —
1898
1900
1910
1911
1920
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940 .
1941
1942
1943
Cornwall.
156
126
85
129
59
51
•54
54
52
57
46
51
49
50
59
48
52
46
36
England & Wales.
160
154
105
130
80
60
66
65
64 '
59
57
59
58
53
50
55
59
49
49
36
The Infant Mortality rate for this County has now reached a record
low hgure wliich is well below that for England and Wales. In the year
1900 more than a thousand children under the age of one year died in this
County giving an Infant Mortality rate of 126 per thousand live births, Last
year the number of children under the age of one year who died in the
County was only 178, representing an Infant Mortahty rate of 36 per
thousand, the lowest rate ever recorded in this County and far below the
rate (49) for England and Wales. The reduction in the death rate of these
young children means that having regard to the present birth rate, there were
saved last year tlie lives of 448 young children who would have died had
the Infant Mortality rate been what it was in 1900.
Work of the Cornwall County Nursing Association for the Year 1943.
Number of District Nursing Associations ... 12 1
Number of Nurses employed ... ... 152
19 are Queen’s Nurses.
21 are State Registered Nurses and State Certified Mid wives.
112 are State Certihed Midwives.
New Patients attended.
Medical ... ... ... ... ... 7 >^55
Surgical ... ... ... ... ... 4.904
Midwifery and Maternity ... ... ... 2,782
15.521
Visits Paid.
General 191.857
Midwifery ... ... ... ... ... 31,414
Maternity ... ... ... ... ... 21,408
Casual ... 44.833
Ante-natal Visits ... ... ... ... 19.515
Health Visits ... ... ... ... 70,745
Operations attended ... ... ... 270
Nights on duty ... 1,865
Work of the Health Visitors. The following is the work of the whole-
time Health Visitors and District Nurses acting as Health Visitors: —
1942.
1943-
Health visits to mothers and children ...
64,052
70.745
Attendances at Clinics and Treatment Centres
265
1,199
Visits to tuberculosis patients
2,343
2,881
Lectures and talks to mothers
169
248
School Medical inspections attended
536
420
School Cleanliness inspections attended
2,825
3,903
School children followed up
10,471
12,564
Visits to boarded out children
580
789
Excluding the Boroughs of Penzance and Falmouth, which have
separate Maternity and Child Welfare Schemes, the County Health Visitors
with the District Nurses acting for tlie County Council made the following
visits: —
37
To Expectant Mothers —
1941.
1942.
1943-
First visits
3.079
3.321
3.701
Total visits
16,429
19.293
19.787
To children under i year of
age—
First visits
3.529
3.928
4.236
Total visits
23,531
30.703
31.517
To children between the ages
of I and 5 years —
Total visits
26,964'
34.757
39.228
Infant Welfare Centres. No Centres are maintained by the Council. The
following Centres are maintained by Voluntary Associations in the County
Maternity and Child Welfare Area: —
Bodmin.
Bade.
Callington.
Camborne.
Camelford.
Delabole.
Downderry.
Grampoiind Road.
Hayle.
Illogan (Pool).
Launceston.
Liskcard.
Looe.
Padstow,
Penryn.
Perranporth.
Perranwell.
Portscatho.
Redruth.
St. Agnes.
St. Austell.
St. Blazey and Par.
St. Day.
St. Mawes.
Tintagel.
Truro.
Wadebridge.
Total number of children who attended at the Centres for the first time
during the year: —
1938,
Number of Centres
22
(i) Children under 1 year of age
(ii) Children between the ages of
532
1 and 5 years
306
Percentage of notified live births
represented in (i) above ...
16.24
1939.
1940.
1941.
1942.
1943.
23
22
26
23
27
541
868
1,186
829
949
320
697
636
301
380
15.37
22.31
26.40
16.76
23.12
In a rural county such as Cornwall most mothers find the distances too
great to attend the Centres, and the Health V,isitors follow up cases to their
homes.
Ophthalmia Neonatorum.
Cases
vision
Unimpaired.
vision
Impaired.
Total
Blindness.
Deaths
Noti-
fied.
Trea
At
Home.
ted
In
Hospital.
28
16
8
28
—
—
—
Many of the cases notified were very mild. An emergency nurse is
supplied for home nursing when necessary.
38
Child Life Protection. 68 persons receiving children for reward were on
the Register at the end of the year and 104 such children were registered.
Squint. Arrangements are made for the examination of children under
school age with Squint, and for the provision of glasses in necessitous cases.
9 children under school age were so examined during the year, and glasses
provided free in 2 cases.
Nursing Homes Registration. There are 25 registered Nursing Homes.
Exemption from registration has been granted to 15 Hospitals. No powers
have been delegated.
ORTHOPAEDIC TREATMENT.
Clinics. There are 13 Orthopaedic Clinics in the County which are run
by the County Council in conjunction with the Cornwall Committee for the
Care of Cripples. The relationship between the County Council and the
Cornwall Committee for the care of Cripples is so intimate that it is not easy
to say precisely where the functions, of the one ends and the other begins.
Broadly speaking, the County Council pays for the services of the consulting
Orthopaedic Surgeon and the Orthopaedic Sisters, pays the rent of the
premises, and makes a grant towards the cost of transport. The Cornwall
Committee for the Care of Cripples undertakes the vast amount of voluntary
work involved in the actual running of the Clinics. Only those assisting
with the administration of the Scheme can possibly realise the hours of
devoted work which have for years been spent by Mrs. Martin, Honorary
Secretary of the Committee, and her voluntary helpers and clinic secretaries
in building up the Service to its present level of efficiency under the general
guidance of Mr. W. W. Rentoul, the consulting Orthopaedic Surgeon. ^
It is being increasingly recognised that the proper place for Clinics of all
kinds is the out-patient department of a general Hospital wherever possible,
and steps are being taken to bring the Orthopaedic Clinic Service into closer
relationship with the larger general Hospitals.
Following are particulars of the present Clinics: —
Clinic.
Where held.
Day & time.
Doctor’s day.
St. Just
Women’s Institute.
2nd & 4th
Second
Thursdays,
Thursday.
10 a.m.
Penzance
West Cornwall Hospital.
Thursdays,
Last
1.30 p.m.
Thursday.
Helston
Public Assistance Institu-
Mondays,
Third
tion.
10 a.m.
Monday.
Camborne
Church Mission Hall,
Wednesdays,
Fourth
-
Trelowarren Street.
10 a.m.
Wednesday.
Falmouth
Falmouth Hospital
Tuesdays,
Second
2 p.m.
Tuesday.
Truro
The Royal Cornwall
Mondays,
First
Infirmary.
2 p.m.
Monday.
39
Newquay
Dartford Physical Training
College, Kingsfield,
Pentire.
2nd & 4th
Fridays,
1.30 p.m.
Second
Friday.
St. Austell
Health Centre, Moorland
Road.
Tuesdays,
10 a.m.
Third
Tuesday.
Bodmin
Centenary Assembly Rooms,
Fore Street.
ist & 3rd
Fridays,
2 p.m.
First
Friday.
Wadebridge
Congregational Church
Rooms, Molesworth Rd.
Fridays,
10 a.m.
Third
Friday.
Liskeard
Welfare Centre, Fair Park
Road.
Saturdays,
10 a.m.
Second
Saturday.
Camelford
St. John Ambulance
Brigade Hall.
2nd & 4th
Friday.
10 a.m.
Fourth Friday
in February
and at 2
monthly inter-
vals.
Bude
Women’s Institute.
9
Fridays,
2 p.m.
Third Friday
in Janua^
and at 2
monthly inter-
vals.
The Clinics at Penzance and Falmouth are provided in conjunction with
the Penzance and Falmouth Local Education Authorities.
There are in addition the following Clinics: —
Launceston. — (Maintained by the Devonian Association).
Doctor’s day: ist Monday in the month at 2.30 p.m.
Mount Gold, Plymouth. — (Maintained by the Plymouth City
Council). Doctor’s days: 2nd and 4th Fridays in the month
at 2.30 p.m.
Hospitals.
Truro. — The Royal Cornwall Infirmary, Truro.
Plymouth. — The Mount Gold Hospital, Mount Gold Road, Plymouth.
Exeter. — The Princess Elizabeth Orthppaedic Hospital, Buckerell
Bore, Exeter.
Ivybridge. — The Dame Hannah Rogers’ Orthopaedic Hospital,
Ivy bridge, Devon.
The number of Orthopaedic beds at the Royal Cornwall Infirmary,
Truro, is 42.
Particulars of tlie work of the Clinics is shown in Table IV at the
end of the Report.
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41
TABLE I.
Infectious Diseases notified in each district during the Year 1943.
Sakitabt
])ISTBI0T
Smallpox
Diphtheria
Urban
Bodmin
1
Bude-Stratton
-
Oamborne-Redruth
29
Falmouth
-
1
Fowey
-
Helstoii
-
7
Launceston
-
Liskeard
-
Looe
-
Lostwithiel
-
Newquay
-
2
Padstow
-
Penryn
-
Penzance
-
88
8t. Austell
-
9
St. Ives
-
O
St Just
-
5
Saltash
-
3
Torpoint
-
1
Truro City
•
6
Totai-s
-
163
Rural
Caiuelford
2
Kerri er
5
Launceston
1
Liskeard
2
St. Austell
. 2
St. Gormans
11
Stratton
Truro
4
Wadebridge
8
West Penwith
37
Totals
72
Whole County
225
Scarlet Fever
Typhoid Fever
Paratyphoid Fever
Erysipelas
Puerperal
Pyrexia
Ophthalmia
Neonatorum
Encephalitis
Lethargica
Acute
Polio-Encephalitis
1 Acute
Poliomyelitis
Oerehro-Spinal
Fever
Pneumonia
Malaria
Dysentery
.5
CO
c3
a
Whooping Cough
Totals
1
48
50
1
. .
1
35
14
32
13
3
47
2
4
424
14
617
5
1
3
6
2
1
18
137
8
181
3
1
6
2
12
1
1
9
2
2
7
49
2
62
2
1
2
9
6
3
23
4
1
3
8
1
17
1
35
1
1
8
6
4
20
12
1
1
2
2
1
1
100
28
150
4
1
1
6
1
3
1
5
1
68
9
88
22
1
2
1
1
1
4
5
36
52
213
15
3
.1
1
4
147
74
256
1
1
15
7
21
47
7
i
2
9
1
I
26
4
5
1
20
165
24
222
8
1
8
12
7
37
2
1
2
5
13
28
118
2
4
40
64
18
1
18
172
4
64
1195
250
2083
4
5
1
2
2
9
62
87
1
2
5
1
1
5
3
3
45
13
84
4
3
1
9
20
3
41
34
4
3
1
1
17
76
7
145
2
2
1
2
12
79
32
132
17
7
4
1
49
1
368
20
478
1
1
12
1
2
0
3
2
1
19
106
53
205
30
1
1
3
12
2
1
10
24
92
6
1
2
1
1
19
1
10
10
88
111
5
2
31
16
6
10
141
5
7
723
224
1353
229
7
6
71
1
24
1
1
28
313
9
61
1918
474
3436
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43
TABLE n.
(a) ANALYSIS OF CASES TREATED AT THE COUNTY ISOLATION HOSPITAL, TRURO (in age groups of years).
Year ended 31st December, 1943.
0—
1-
5-
15-
20^
25-
30—
35-
45-
55—
65—
Disease
TOTAL.
Deaths
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M F
M F
Diphtheria : —
Cases.
2
—
11
5
37
44
11
19
13
13
5
10
1
6
4
10
—
1
1 —
193
44.06%
6
Carriers
—
—
4
—
12
5
—
—
1
—
—
1
—
1
—
1
—
—
25
5.71%
—
Contacts
1
—
—
—
1
—
—
1
—
—
—
—
—
3
.68%
—
Scarlet Fever
...
1
—
6
9
22
42
5
3
2
6
—
1
2
2
2
2
—
105
23.97%
1
Cerebro-Spinal F.
2
2
1
5
2
—
—
—
1
2
—
3
1
2
1
—
— — '
— —
22
6.02%
3
Mumps
_
1
—
1
—
2
■46%
Chicken Pox
—
—
—
—
^
—
—
—
—
—
—
—
Rubella
—
~
1
1
.23%
—
Whooping Cough
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
Poliomyelitis
...
—
—
—
1
—
—
—
—
—
1
—
—
—
—
—
—
—
—
2
•46%
—
Encephalitis
—
—
—
—
—
—
1
—
—
—
—
—
—
1
1
—
—
—
3
.68%
—
Erysipelna
—
—
—
—
—
—
—
—
—
—
—
—
1
—
1
—
—
1
3
.68%
—
Typhoid
—
—
1
—
—
—
1
—
—
2
1
—
—
—
—
—
2
1
— 1
1 —
10
2.28%
2
Paratyphoid
—
—
—
—
1
1
—
1
—
1
—
—
—
—
—
—
—
1
5
1.14%
, —
Dysentery
—
—
—
1
—
—
—
—
2
1
1
—
1
—
2
—
—
—
8
1.83%
—
Vincents’ Angina
—
—
—
—
—
—
1
1
3
—
2
—
—
—
1
—
—
—
8
1.83%
—
Puerperal Sepsis
—
—
—
Pemphigus Neonatorum
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
Miscellaneous
2
—
—
1
6
5
1
5
4
5
4
2
2
1
1
1
4
3
— 1
48
10.97%
2
6
2
24
18
84
99
20
30
26
31
16
14
10
11
13
16
7
7
1 1
1 1
438
14
8
42
183
50
57
30
21
29
14
' 2
'2
1.83%
9.59%
41.78%
11.41%
13.01%
6.85%
4.79%
6.62%
3.20%
.46%
.46%
(b) ANALYSIS OF CASES TREATED AT THE WESTWARD HO! ISOLATION HOSPITAL, NEWQUAY (in age groups of years) .
Year ended 31st December, 1943.
Disease.
0— 1—
M F M F
5—
M F
15—
M F
20—
M F
25—
M F
so-
il F
35—
M F
45—
M F
55—
M F
65—
M F
TOTJS
lL.
Deaihfl
Chicken Pox
Measles
Mumps
Rubella
Whooping Cough
Miscellaneous
— — 12 12
— — 13
— — 3 —
— 1 3 —
4 4
7 4
Ui
2 —
2 2
4 1
— 3
6 1
6 5
2 8
— 1
1 2
3 1
4 —
2 —
3 1
2 —
1 —
1 —
2 —
3 —
— 1
— —
— —
45
39
27
3
8
8
.34.62%
30.00%
20.77%
2.31%
6.16%
6.16%
-
— 1 19 15
14 11
8 6
15 17
7 i
9 1
5 —
— 1
-
-
130
1 34
25
14
32
8
10
'5
i
—
—
.77% 26.15%
19.23%
10.77%
24.62%
6.15%
7.69%
3.85%
.77%
43
MISCELLANEOUS CASES.
County Isolation Hospital, Truro.
Streptococcal infections
Streptococcal infection contact
Tonsillitis
Not infectious
Sub-arachnoid haemorrhage
Not infectious
Quinsy
Pyelitis
Myocardial degeneration
B. Coli infection
Influenza ...
? Renal ...
T. B. Meningitis
Non-specific enteritis
Infective hepatitis
Lymphocytic meningitis
Post-diphtheritic cordiac complication
Meningicoccal encephalitis
Nettle Rash
Urticaria
Transverse Myelitis
Cervical Adenitis
?Peritonitis
Neoplasm Chest
Herpes
48
1 (infant — with mother)
8
6 (all ? C.S.F.)
2
2 (? Scarlet Fever)
2
2 (a member of staS — admitted twice)
I (a member of staff)
I
I
I
j (died)
(? Poliomyelitis)
(? Paratyphoid)
(? Typhoid — Died)
Westward Ho! Isolation Hospital, N
Scarlet Fever
Urticaria
Not infectious
Insect Bites
Influenza
Cervical Adenitis
Toxic Erythema
ewquay. '
I
1 ( ? Measles)
2 (i ? Rubella and i ? Chicken Pox)
I ( ? Chicken Pox)
I ( ? Measles)
I (? Mumps)
I ( ? Measles)
8
44
TABLE UI.
STATEMENT OF TUBERCULOSIS— ANNUAL RETURN 1943.
Pulmonary.
Non-Puhnonary.
Total.
Grand
Total.
Adults
Children
Adults Children
Adults
Children
A.
M.
F.
M.
F.
M.
F. M.
F.
M.
F.
M.
F.
(i) Number of definite Cases of
Tuberculosis on Register at
beginning of Year
505
339
II
9
105
108 49
46
610
447
60
55
1,172
(2) Transferred from other Counties
(3) Lost sight of Cases returned
23
20
—
—
I
I I
2
24
21
I
2
48
during the year
I
—
—
—
—
I
—
—
—
I
B.
Number of New Cases diagnosed
1
as TB during the year —
fi) TB —
33
21
I
I
1 114
80
13
II
218
(2) TB +
71
46
I
2
Total TB — and TB +
104
67
2
3
.
(3) Non Pulmonary
—
—
—
—
10
13 II
8
'
C.
Number of Cases Written off during
the year: —
(i) Recovered
12
13
_
I
4
I
2
16
13
I
3
33
(2) Dead (all causes)
59
40
I
2
6
2 I
I
65
42
2
3
II2
(3) Removed to other Areas
26
19
—
I
4
2 5
I
30
21
5
2
58
(4) For other Reasons
4
4
—
—
—
I I
4
5
I
10
D.
Number of definite Cases of TB on
Dispensary Register at end of
year
534
351
10
7
104
121 51
48
638
472
61
55
1,226
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' ' '
43
TABLE IV. ORTHOPAEDIC TREATMENT.
ATTENDANCES AT CLINICS AND NUMBERS ON REGISTERS, 1943.
(including the Boroughs of Penzance and Falmouth).
Clinic.
Attendances on
New Cases.
Surgeon’s Days.
Total Attendances.
Total Attendances
on all Days.
Number of Cases on Register,
on 31.12.43.
Under
School
Tuber-
Under
School
Tnber-
Under
Tuber-
Under
Tuber-
School
culosis.
Total.
School
ctilosis.
Total.
School
culosis.
Adults.
Total.
School
School
culosis
Adults.
age.
age.
(all ages)
age.
® (all ages)
age.
age.
(all ages]
age.
age.
(all ages]
St. Just
2
14
—
16
21
238
47
306
Ill
977
58
53
1199
3
56
8
9
76
Penzance (County cases)
23
53
—
76
119
295
52
466
340
1951
88
471
2850
33
140
II
93
277
(Borough cases)
—
30
—
30
—
177
—
177
)
Helston
8
44
I
53
75
381
35
491
) 140
1303
99
322
1864
28
118
12
66
224
Camborne
19
51
—
70
123
419
46
588
257
1496
157
525
2435
56
207
25
142
430
Falmouth (County cases)
28
33
—
61
165
193
42
400
1 449
1433
95
223
2200
53
III
12
52
228
(Borough cases)
—
12
—
12
—
177
177
Truro
55
87
—
142
369
875
85
1329
708
3694
233
228
4863
122
230
30
50
432
5t. Austell
30
109
I
140
288
878
40
1206
I 578
4144
148
497
5367
100
300
18
136
554
Bodmin
12
39
—
51
44
369
14
427
53
1247
35
156
1491
33
115
4
58
210
Wadebridge
29
40
—
69
108
501
13
622
, 212
2744
23
319
3298
65
167
2
82
316
Liskeard
33
87
—
120
161
552
16
729
382
2559
48
608
3597
74
258
12
138
482
Newquay
48
38
I
87
59
465
22
546
78
2994
114
322
3508
14
151
5
29
199
Camelford
II
24
—
35
50
124
—
174
129
474
4
150
757
21
57
I
21
100
Bude
14
45
—
59
74
231
5
310
168
1033
28
65
1294
30
91
2
19
142
Totals of County
Council Clinics
312
706
3
1021
1656
5875
417
7948
3605
26049
1130
3939
34723
632
2001
142
895
3670
Launceston
9
37
—
46
39
243
—
282
49
299
—
—
348
15
57
—
—
72
Mount Gold
—
—
—
—
—
5
—
5
—
7
—
—
7
—
2
—
—
2
Totals of Cornish Cases
321
743
3
1067
1695
6123
417
8235
3654
26355
1130
3939
35078
647
2060
142
895
3744
MATERNAL MORTALITY.
GRAPHS.
The main features to be observed are as follows: —
1. Mortality from causes other than sepsis.
(a) In both Cornwall and the country as a whole the rate remained
more or less stationary from about 1920 till the early 1930’s. Soon after
1935, a remarkable decline in the rate began. It must be noted that this is
a national phenomenon and Cornwall has taken its part in the change.
(b) There is a suggestion that the rate for Cornwall has improved
relatively more than has that for the country as a whole, that the County
has more than made up its leeway.
2. Mortality from puerperal sepsis.
The Cornwall rate has again followed the national rate closely and
the remarkable fall resulting from the coming into use of the drugs of the
sulphonamide group in 1934 is well shown. In this case, it seems possible
that Cornwall may have improved relatively less than has the country at
large.
The discovery of the sulphonamides and the general realization of the
great importance of streptococcal infection in maternal sepsis mortality
renders it of interest to add to the graph curves showing the incidence of,
and mortality from, erysipelas in England and Wales. This condition is
due to haemolytic streptococci and the parallelism between these curves and
those of maternal mortality from sepsis is very remarkable. The erysipelas
rates are dependent entirely on, and are sensitive indicators of, the varying
intensity of streptococcal infection and it is clear that the maternal mortality
from sepsis is to a very large extent similarly determined; this last fact is
well shown, in the graphs, for both Cornwall and the country as a whole.
MATERNAL MORTALITY
RATES PER 1.000 LIVE BIRTHS, CORNWALL ( ADMINISTRATIVE COUNTY) AND ENGLAND & WALES, 1914 bo 1943, FOR CAUSES OTHER THAN SEPSIS.
1.0-
k
UJ
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YEAR
1915
1920
T I I I I
1925
1930
1935
1 1 1 I I r
1940
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RATE
MATERNAL
mortality
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z.o-
1.0-
k
RATES per thousand live births, due to sepsis, for C O R N W A L L (ADMINISTRATIVE COUNTY) and ENGLAND & WALES, 1914 to 1943, together with
erysipelas case rates (per 100,000 population) and erysipelas death rates (per million population) for ENGLAND & WALES in those years.
Erysipelas case rates, England &Wales .
Erysipelas death rates, England & Wales
Maternal Mortality (sepsis), England & Wales
Maternal Mortality (sepsis), Cornwall (quinquennia) 0
1912 1914 _ I9I6
1918
YEAR
1920 1922
1924
1926 i928 1930 1932 1934 1936 1938 1940 1942 1944
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9
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